Acetaminophen (Tylenol) is the safest over-the-counter pain reliever and fever reducer during pregnancy, though even it should be used sparingly and at the lowest effective dose. Beyond that, your options depend on what symptoms you’re dealing with. Many common cold, flu, and stomach remedies are fine during pregnancy, but several popular ones carry real risks, especially in the first trimester.
Here’s a symptom-by-symptom breakdown of what’s considered safe, what to avoid, and what non-drug options actually work.
Fever and Pain Relief
Acetaminophen remains the go-to for headaches, body aches, and fever during pregnancy. It’s the safest option among all over-the-counter pain relievers. That said, the FDA has noted accumulating evidence linking prolonged acetaminophen use throughout pregnancy with a slightly increased risk of neurological conditions like autism and ADHD in children. A causal relationship hasn’t been established, and the data is mixed, but the recommendation is to use the lowest dose that works and avoid taking it routinely for minor discomfort like low-grade fevers.
Ibuprofen (Advil, Motrin) and naproxen (Aleve) are not clearly safe in the first trimester and can cause birth defects in the third trimester. Aspirin also has well-documented fetal risks. Avoid all three unless specifically directed by your provider.
When a Fever Needs Attention
A sustained fever above 102°F (38.9°C) lasting at least 24 hours has been linked to an increased risk of miscarriage in early pregnancy, neural tube defects like spina bifida, and stillbirth later on. If your temperature stays elevated, contact your doctor rather than trying to manage it at home.
Nasal Congestion
This is where things get tricky. Oral decongestants like pseudoephedrine (Sudafed) and phenylephrine are among the most commonly used over-the-counter medications in pregnancy, and many people assume they’re safe because they don’t require a prescription. But first-trimester use of these medications has been associated with several specific birth defects. Phenylephrine has been linked to heart defects, and pseudoephedrine to abdominal wall defects and limb abnormalities. The odds are still small in absolute terms, but the associations are consistent enough that most guidance now recommends avoiding oral decongestants, particularly in the first trimester.
Nasal spray versions of decongestants aren’t necessarily safer. Even though they’re applied locally, they absorb well through the nasal lining and produce systemic effects similar to oral forms.
Your best option for congestion is saline nasal spray or saline rinses, which contain no medication at all. A humidifier can also help loosen mucus, though you need to keep it clean to avoid circulating mold or bacteria. Adhesive nasal strips (like Breathe Right) are another drug-free option. They won’t cure congestion, but they physically widen the nasal passage and can make breathing and sleeping easier.
Cough and Sore Throat
Guaifenesin, the active ingredient in Mucinex, is an expectorant that thins mucus so you can cough it up more easily. Available evidence suggests it is not expected to significantly increase the chance of birth defects, though studies on pregnancy complications like preterm delivery haven’t been done. If you use a guaifenesin product while pregnant, choose an alcohol-free formula.
Dextromethorphan, the cough suppressant in many “DM” products, is generally considered low-risk during pregnancy. Many combination cold medicines contain both guaifenesin and dextromethorphan, but check the label carefully. Combination products often also include decongestants or other ingredients you may want to avoid. Single-ingredient products are the safer bet.
For sore throats, throat lozenges containing benzocaine (a topical numbing agent found in brands like Orajel and Cepacol) are considered low-risk. Very little benzocaine is absorbed into the bloodstream when used as directed, making it unlikely that a significant amount reaches the fetus. Two reports found no increased chance of birth defects from first-trimester use. Lozenges with menthol and honey are also fine during pregnancy. Despite the common confusion, the warning about honey applies only to infants under one year old, not to pregnant women.
Honey mixed with warm water or tea can soothe a sore throat and help thin secretions so coughing is more productive. It’s one of the simplest and safest remedies available.
Allergies and Sinus Symptoms
No antihistamine has been formally declared safe in pregnancy based on controlled studies, but some have far more reassuring data than others. The American College of Obstetricians and Gynecologists and the American College of Allergy, Asthma and Immunology recommend chlorpheniramine as a first-choice antihistamine for pregnant women. It’s a first-generation antihistamine (the older, drowsier type), and it has the longest track record of use in pregnancy with reassuring safety data.
If chlorpheniramine doesn’t work well enough or you can’t tolerate the drowsiness, loratadine (Claritin) and cetirizine (Zyrtec) are recommended as second-line options after the first trimester. Both have been widely studied for potential birth defect risks and have been found to be non-teratogenic. Diphenhydramine (Benadryl) is another first-generation option with a long history of use, though it’s quite sedating.
Upset Stomach and Heartburn
Illness during pregnancy often comes with nausea, heartburn, or acid indigestion on top of everything else. Calcium carbonate antacids like Tums, Rolaids, and Maalox are not expected to increase the chance of miscarriage or birth defects when used within recommended amounts. They also provide supplemental calcium, which is beneficial during pregnancy.
The key is sticking to the recommended dose. Overuse of calcium carbonate has been linked to low birth weight, and there are case reports of newborn seizures when very high doses were taken near the end of pregnancy. Used normally, though, these are among the safest options for digestive discomfort.
If You Get the Flu
Influenza is more dangerous during pregnancy than at other times. Pregnant women are at increased risk for serious flu complications, which is why the CDC recommends antiviral treatment for any pregnant person with suspected or confirmed flu, regardless of severity or trimester. The preferred antiviral is oseltamivir (Tamiflu), a five-day oral course that works best when started within 48 hours of symptom onset, though it still offers benefit when started later. Multiple observational studies have found oseltamivir to be safe during pregnancy with no increased risk of adverse outcomes.
You don’t need a positive flu test to start treatment. Rapid flu tests can miss cases, and waiting for results delays treatment. If you have flu symptoms during flu season, call your provider promptly. This is a prescription medication, not something available over the counter.
Non-Drug Strategies Worth Trying First
For mild cold symptoms, starting with drug-free approaches makes sense. Saline nasal rinses for congestion, honey and warm liquids for sore throat, a clean humidifier to add moisture to dry air, and nasal strips at night for easier breathing are all safe and carry zero medication exposure. An electric blanket set to a comfortable level (they typically range from 86°F to 122°F) can help with body chills, though you’ll want to avoid prolonged exposure to high heat.
Rest and hydration matter more during pregnancy than usual because your immune system is naturally suppressed. Many mild colds will resolve on their own within a week. If symptoms are manageable, non-drug approaches may be all you need. When they aren’t enough, the medications above, used individually at the lowest effective dose for the shortest time necessary, give you a reasonable set of options.